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Predictors of long-term survival after hip fractures?—5-year results of a prospective study in Germany

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Abstract

Summary

The incidence of hip fractures is increasing due to demographic transition. Data on long-term survival and influencing factors are sparse. Our prospective observational study with 395 patients shows a survival of 38% after 5 years. Significant risk factors were male gender, higher age, lower Barthel Index, lower Charlson Comorbidity Score, lower Mini-Mental State Examination, and delirium during hospitalization.

Purpose

The incidence of hip fractures is increasing due to demographic transition. Until now, they are associated with poor results and high mortality rates. Data on long-term survival and influencing factors are sparse. Therefore, a prospective observational study was conducted.

Methods

Patients ≥ 60 years with hip fracture were included in this prospective study between 2009 and 2011. Demographic parameters, as well as ASA Score, pre-fracture Barthel Index and EQ-5D, Mini-Mental State Examination, Charlson Comorbidity Score, fracture type, type of surgical treatment, place of discharge, and arising complications were registered. Outcome parameter was survival during a 5-year follow-up period.

Results

A total of 539 patients attended to our emergency room during the period of recruitment. The recruitment rate was 75%. A total of 402 patients were included; 7 were lost to follow-up, and 152 (38%) survived the study period. The mortality was more than 25% in the first year after fracture. Subsequently, it was between 7 and 9% per year. In the multivariate analysis, significant risk factors for dying were male gender (p = 0.002), higher age (p < 0.001), lower Charlson Comorbidity Score (p = 0.033), lower Barthel Index (p = 0.024), lower Mini-Mental State Examination (p = 0.002), and occurrence of delirium during hospitalization (p = 0.008).

Conclusion

Our results confirm poor results of geriatric patients after hip fracture. While early results might be influenced by optimal fracture care, long-term results seem to be determined by not changeable patient factors. Nevertheless, more than one third of surviving patients after 5 years justify the elaborate treatment algorithms for these fragile patients.

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Authors and Affiliations

  1. Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Baldingerstrasse, 35043, Marburg, Germany

    Tom Knauf, Benjamin Bücking, Mathias Bargello, Sebastian Ploch, Christopher Bliemel, Steffen Ruchholtz & Daphne Eschbach

  2. Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany

    Matthias Knobe

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  1. Tom Knauf
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  2. Benjamin Bücking
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  3. Mathias Bargello
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Correspondence to Benjamin Bücking.

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The study has been approved by the Ethics committee of the University of Marburg. Informed consent was obtained from all individual participants included in this study.

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Knauf, T., Bücking, B., Bargello, M. et al. Predictors of long-term survival after hip fractures?—5-year results of a prospective study in Germany. Arch Osteoporos 14, 40 (2019). https://doi.org/10.1007/s11657-019-0586-1

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